A Drug for Blood Pressure, and also for Beta Cells?

Many scientists enter their fields hoping that their work will directly impact people’s lives. That is exactly what Anath Shalev, M.D., of the University of Alabama at Birmingham (UAB), wanted to do for type 1 diabetes (T1D). Dr. Shalev is the director of the Comprehensive Diabetes Center at UAB, and through her research to find ways to protect the insulin-producing beta cells in T1D came across a protein that is increased in beta cells that are stressed by T1D. In 2007, she sent a proposal to JDRF to fund research on this protein and to test if decreasing it could enhance beta cell survival and protect against diabetes in lab animals. The work progressed well and Dr. Shalev found that an approved blood pressure medication could reduce levels of the protein in beta cells and protect mice from diabetes.

It’s now 2018, and Dr. Shalev has received three grants from JDRF, the last one to fund a clinical trial of verapamil, a calcium channel blocker that lowers the protein involved in the progression of T1D. It is a bench-to-bedside research project—going from basic research at the laboratory through a clinical trial in patients—that JDRF has had a hand in for more than a decade. The results are out and look very promising.

Published today by Nature Medicine, the clinical trial showed that verapamil, administered in newly diagnosed adults with T1D, helps to slow progression of T1D and promote insulin production by preserving beta cell function. As a result, the patients who received verapamil in this study needed less insulin and had better glycemic control, with fewer highs and lows, than those that received placebo. This was a relatively small study, and more work will be needed to confirm these results and understand how this might be best used to treat T1D, but provides a powerful proof-of-concept that controlling beta cell stress can slow down progression of T1D.

Dr. Shalev was able to take her research from the lab bench to the clinic so quickly because verapamil was approved by the U.S. Food and Drug Administration (FDA) in 1981, and is widely available to treat high blood pressure. This repurposing of a drug for T1D provides an accelerated path to clinical testing and, if successful, to people with T1D, than if a brand-new drug were being tested.